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Home Health Quality Reporting Reconsideration and Exception & Extension

Home Health Quality Reporting Reconsideration and Exception and Extension

The Reconsideration Requests webpage provides information and updates related to the reconsideration process for the Home Health Quality Reporting Program (HHQRP). On this page, you will find guidelines and processes for submitting reconsideration requests and requests for exceptions and extensions, effective date 1/1/2018. For questions related to content posted on this page, please contact the CMS HHA APU Reconsiderations Team at HHAPUReconsiderations@CMS.hhs.gov.

Home Health QRP: Natural Disaster Protocol

Home Health Agencies (HHAs) affected by natural disaster(s) in counties that are identified through the Federal Emergency Management Agency (FEMA) as “Designated Areas” will be provided guidance and further information via this webpage with respect to data submission requirements, as it becomes available.

In addition, details and materials are also available on the CMS Emergency Response and Recovery webpage.

Please note- designated areas may be updated to add affected areas by natural disasters. Please continue to check back frequently for updates.

HH QRP Reconsideration and Appeals Procedures for Payment Determination

In the CY 2015 Home Health Prospective Payment System Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the HH QRP requirements for the CY 2016 APU and forward. Any HHA determined to be non-compliant with the HH QRP requirements are subject to a two (2) percentage point reduction in their annual payment update (APU).

Any HHA found non-compliant according to the quality reporting requirements will receive a letter of notification from the United States Postal Service (USPS) which will include instructions for requesting reconsideration of this decision. In addition, all Medicare-certified HHA non-compliance letters will be uploaded into the Certification and Survey Provider Enhanced Reports (CASPER) folders within the Quality Improvement and Evaluation System (QIES) for each HHA to access. Instructions to download files in QIES may be found at https://www.qtso.com/hhadownload.html.

For the annual payment determination, HHAs must comply with the requirements for submitting OASIS data and for monthly participation in the Home Health Consumer Assessment of Healthcare Providers & Systems (HHCAHPS) survey.

  • OASIS Submission: HHAs are expected to submit a minimum set of two “matching” OASIS assessments for each patient admitted to their agency, to create quality episodes of care for quality measurement purposes. Compliance is measured by the percent of assessments that are considered “Quality Assessments Only” (QAO). More information on the QAO calculation and requirements is available on the Home Health Quality Reporting Requirements page.
  • HHCAHPS: All Medicare-certified HHAs must participate every month in the HHCAHPS Survey and contract with an approved HHCAHPS vendor to collect data from their respective home health care patients. The HHCAHPS data collection year begins April 1 and ends March 31 of the following year. More information on HHCAHPS requirements, including exemptions, is available on the official CMS website, https://homehealthcahps.org.

What is Reconsideration?

Reconsideration is a request for a review of the initial CMS compliance determination for a given HHA for a given calendar year (CY).

When Would a HHA Submit a Reconsideration Request?

HHAs may file for reconsideration if they believe the CMS finding of non-compliance is in error, or they have evidence of the impact of extraordinary circumstances which prevented timely submission of data. HHAs would have 30 days from the date at the top of the letter of noncompliance to submit this request for reconsideration to CMS.

Important Note: A request for reconsideration due to a deficiency in the Home Health reporting of data as required in the Home Health QRP due to a disaster is separate and aside from the waiver requirements and purposes pursuant to 42 CFR §484.250(d).

Create a Reconsideration Request

To apply for reconsideration, the HHA must receive a CMS letter of non-compliance. An HHA disagreeing with the payment reduction decision may submit a request for reconsideration to CMS within thirty (30) days from the date at the top of the non-compliance notification letter distributed electronically using QIES. CMS will not accept any requests submitted after the thirty (30) days deadline. For the CY 2018, the reconsideration period was October 2, 2017-October 31, 2017.

Reconsideration Request

Please note: The only method for submitting reconsideration requests is via email. Requests submitted by any other means will not be reviewed for reconsideration.

Here are key required elements of a reconsideration request:

  • HHAs are required to submit their request to CMS via email with the subject line: “HHA QRP Reconsideration Request” and include the HHA CMS Certification Number (CCN) (e.g., HHA QRP Reconsideration Request, XXXXXX).
  • The request must be sent to the following email address HHAPUreconsiderations@CMS.hhs.gov
  • The email request must contain the following information:

    • HHA CMS Certification Number (CCN);
    • HHA Business Name;
    • HHA Business Address;
    • CEO or CEO-designated personnel contact information including name, telephone number, email address, and mailing address (the address must be a physical address, not a post office box); and
    • CMS identified reason(s) for noncompliance from the non-compliance notification letter; and
    • The reason(s) for requesting reconsideration; and
    • Information supporting the HHA belief that either non-compliance is in error, or evidence of the impact of extraordinary circumstances which prevented timely submission of data

Please note: Do not include protected health information (PHI) or other Health Insurance Portability and Accountability Act (HIPAA) violations in the documentation being submitted to CMS for review. We cannot review requests including PHI. You will be asked to destroy the PHI and resubmit your request. 

The request for reconsideration must be accompanied by supporting documentation demonstrating compliance. CMS will be unable to review any request that fails to provide the necessary documentation along with the request for reconsideration. Supporting documentation may include any or all of the following:

    • Proof of submission
    • Email communications
    • Data submission reports from the Quality Improvement Evaluation System (QIES)
    • Proof of approved exception or extension for the reporting time frame
    • Copy of the CCN activation letter
    • Other documentation supporting the rationale for seeking reconsideration

Reconsideration Request Process Timeline

Below is the estimated CMS reconsideration process timeline for FY 2018 Annual Payment Update determination:

  • Late September 2018 - CMS issues notices of non-compliance to HHAs that failed to meet quality reporting requirements
  • Late October 2018 - Reconsideration requests are due to CMS no later than thirty (30) days from the date on the notification of non-compliance

CMS provides an email acknowledgement within five (5) business days upon receipt of reconsideration request.

  • Mid December 2018 - CMS notifies HHAs of the Agency’s decision on the reconsideration requests via letter from the MACs and/or USPS as well as distributed electronically using QIES.

Filing an Appeal

HHAs dissatisfied with the reconsideration ruling may file a claim under 42 CFR Part 405, Subpart R (a Provider Reimbursement Review Board [PRRB] appeal). Details are available on the CMS.gov PRRB Review Instructions website.

Extraordinary Circumstances: Exception and Extension

Exception and Extension Requests Overview

CMS provides HHAs an opportunity to request an exception or extension from the program’s reporting requirements in the event they are unable to submit quality data due to extraordinary circumstances beyond their control. HHAs affected by a natural or man-made disaster or other extraordinary circumstances may request an exception or extension by filing a Request for Reconsideration Due to Disaster or Extraordinary Circumstance.

Important Note: A request for reconsideration due to a deficiency in the Home Health reporting of data as required in the Home Health QRP due to a disaster is separate and aside from the waiver requirements and purposes pursuant to 42 CFR §484.250(d).

Definitions

  • Extraordinary Circumstances:   Natural or man-made disasters preventing timely submission of quality data. A disaster may be widespread or affect multiple structures or isolated and affect a single site only.
  • Extension:  Submission deadline extended. CMS can extend submission deadlines for the specified deadlines for 30 to 45 days beyond the scheduled due date applicable to other facilities.
  • Exemption: Submission deadline waived. CMS can exempt a facility from submitting quality data for the specified deadlines without impact on the Annual Payment Update.

When an extension/exception is granted, an HHA will not incur payment reduction penalties for failure to comply with the requirements of the HH QRP. Under the finalized process, an HHA may request an extension/exception of the requirement to submit quality data for a specified time period by submitting a written request to CMS. 

This process does not preclude CMS from granting extensions/exceptions to HHAs not requesting an extension/exception when an extraordinary circumstance, such as an act of nature affects an entire region or locale. When an extension/exception to HHAs in a region or locale is granted, CMS will communicate the decision through routine channels to HHAs and vendors, including, but not limited to the PAC QRP listserv, Open Door Forum MLN Connects, PAC and notices on the CMS Home Health Quality Reporting spotlight webpage.

Submission Exception and Extension Process in Cases of Disaster or Extraordinary Circumstances

Here are the key elements of an exception or extension request:

 

  • All HHAs requesting an exception or extension must submit the request within ninety (90) days of the event. CMS may grant the exception or extension for one or more quarters.
  • HHAs must request an exception or extension via email with the subject line, “HH QRP Exception or Extension Request”

 

The email must also include all of the following information:

  • HHA CCN;
  • HHA business name;
  • HHA Business Address
  • CEO or CEO-designated personnel contact information including name, telephone number, email address, and mailing address (the address must be a physical address, not a post office box);
  • Evidence of the impact of extraordinary circumstances, including, but not limited to, photographs, newspaper, and other media articles.
  • A date when the HHA believes it will be able to again submit HH QRP data and a justification for the proposed date.
  • Any other documentation supporting the rationale for seeking reconsideration
  • If you do not have all of this documentation, please explain in your request.

Please note: Never include PHI or other HIPAA violations in the documentation being submitted to CMS for review. CMS will not review requests that include PHI or any data violating HIPAA.

Important Note: Any exception or extension requests submitted for purposes of the HH QRP will apply to that program only, and not to any other program CMS administers for HHAs, such as survey and certification.

Response from CMS

CMS will provide a written acknowledgement upon receipt of the exception and extension request. CMS will notify the CEO or CEO-designated contact provided in the request with the decision, via USPS mail and email.

For More Information

For additional assistance, HHAs may submit questions related to the HH QRP exception and extension request to: HHAPUReconsiderations@cms.hhs.gov.

 

 

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